SPOKANE, Wash. (AP) — Health officials in rural communities in Washington state are worried that Thanksgiving gatherings could take the COVID-19 pandemic from bad to worse and, in some places, overwhelm already strained health systems.

The Spokesman-Review reports the small towns surrounding Spokane County have experienced a surge in cases in recent weeks, mirroring trends seen statewide.

In the past two weeks, the Northeast Tri County Health District, which covers Ferry, Stevens and Pend Oreille counties, reported more than 300 new COVID-19 cases, a record number accounting for a third of their total cases confirmed thus far in the pandemic.

Similarly, Lincoln County has seen more than 50 cases in the past few weeks, which account for a third of the total cases recorded in the county.

“What we’re finding is a lot of our cases that we’ve identified here, we can track back to people in Spokane,” said Ed Dzedzy, public health administrator in Lincoln County. “It’s just the nature of the beast, and it’s not pointing a finger at anybody, but the virus is going to do what it does; People move from rural to urban to buy goods and go to work.”

Lincoln County experienced a few larger outbreaks this month in long-term care settings and one larger family cluster. In the three counties north of Spokane County, outbreaks at social gatherings, workplaces, restaurants, bars and churches have led to a surge in cases.

The Northeast Tri County Health District had to stop contact tracing last week due to so many cases, particularly in Stevens County, which is seeing the highest increase of cases it’s had in all the pandemic. The district is focusing its resources on doing case investigations, reaching out to all people confirmed to have COVID-19, and asking them to reach out to their close contacts.

The Washington Department of Health announced this week that it’s hiring 350 more contact tracers and investigators to support local health jurisdictions by mid-December, which could help smaller health departments meet the challenge of tracing all contacts with cases surging.